Assumption of Risk Acknowledgment

# Assumption of Risk Acknowledgment **Effective Date:** ___________ This Assumption of Risk Acknowledgment ("Agreement") is entered into by: **Participant:** ___________ ("Participant") **Participant Address:** ___________ **Date of Birth:** ___________ **Provider/Organizer:** ___________ ("Provider") **Provider Address:** ___________ ## 1. Activity Description **Activity Name:** ___________ **Activity Location:** ___________ **Activity Date(s):** ___________ **Activity Category:** ___________ **Detailed Activity Description:** ___________ ## 2. Acknowledgment of Risks The Participant acknowledges and understands that the Activity involves inherent risks that cannot be eliminated regardless of the care taken to avoid them. These risks include, but are not limited to: (a) **Physical risks:** Bodily injury, broken bones, sprains, strains, concussions, paralysis, disability, disfigurement, and death. (b) **Environmental risks:** Exposure to extreme weather, temperature, altitude, terrain, water conditions, wildlife, insects, and natural hazards. (c) **Equipment risks:** Malfunction, failure, or improper use of equipment, gear, or machinery. (d) **Human factors:** Actions, omissions, or negligence of the Provider, its employees, instructors, guides, other participants, or third parties.